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研究生:謝氏清竹
研究生(外文):TA THI THANH TRUC
論文名稱:Evaluating fluid balance in critical care: comparison between body weight change and input-output fluid balance
論文名稱(外文):Evaluating fluid balance in critical care: comparison between body weight change and input-output fluid balance
指導教授:曾明月曾明月引用關係
指導教授(外文):TSENG, MING-YUEH
學位類別:碩士
校院名稱:美和科技大學
系所名稱:護理系健康照護碩士班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:英文
論文頁數:76
中文關鍵詞:Critically ill patientsfluid balance monitoringbody weight changesinput-output fluid balance
外文關鍵詞:Critically ill patientsfluid balance monitoringbody weight changesinput-output fluid balance
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Background. The computation of fluid balance by subtracting fluid outputs from inputs is a common critical care practice. Previous studies show that the input-output fluid balance is inaccurate and unreliable in comparison with body weight changes.
Objective. The aim of the study is to evaluate the agreement of input-output fluid balance in comparison with body weight change, as known as the gold standard in fluid balance monitoring.
Method. The study is a prospective, descriptive study carried out in University Medical Center, Ho Chi Minh City, Vietnam from March to May 2019. The measurement of body weight change and input-output fluid balance are performed according to hospital protocol. The significance of the results is analyzed by Bland-Altman plot, limit of agreement, ANOVA test with turkey post-hoc test, independent samples t-test, chi-square test, fisher exact test, at p-value of 0.05 using SPSS version 20.0.
Results. There are total of 96 patients enrolled in the study. The mean age of the entire sample was 71.24 ± 14.89. 32 patients (33%) are classified into shock/septic subgroup, 23 patients (24%) into cardiac/cerebral subgroup, and 41 patients (43%) into other subgroup. The body weight change in the 24-hour period at ICU tends to be positive with the average amount is 35 ± 1427 grams. Otherwise, the input-output fluid balance recorded by nurses demonstrates a consistently negative tendency with average amount is -342 ± 949 mL (mean ± SD). The average difference between the fluid balance measured by two methods is 378 ± 1185 mL (mean ± SD). There are 42 cases (43%) that the difference is larger than 500mL. Within the entire sample, there is no statistically significant difference between the two methods. The Bland-Altman plot above shows that 97% of data points lie within this range, and tend to concentrate around the mean line. The limit of agreement varies from -1945mL to 2702mL. While considering these findings in the clinical setting, the agreement is not good enough to completely eliminate the body weight change out of the clinical practice.
Conclusion. The present study is conducted specifically in Vietnamese patients. There is no statistically significant difference between the body weight change and the input-output fluid balance record. Therefore, it is necessary to maintain both methods in clinical practice.
Background. The computation of fluid balance by subtracting fluid outputs from inputs is a common critical care practice. Previous studies show that the input-output fluid balance is inaccurate and unreliable in comparison with body weight changes.
Objective. The aim of the study is to evaluate the agreement of input-output fluid balance in comparison with body weight change, as known as the gold standard in fluid balance monitoring.
Method. The study is a prospective, descriptive study carried out in University Medical Center, Ho Chi Minh City, Vietnam from March to May 2019. The measurement of body weight change and input-output fluid balance are performed according to hospital protocol. The significance of the results is analyzed by Bland-Altman plot, limit of agreement, ANOVA test with turkey post-hoc test, independent samples t-test, chi-square test, fisher exact test, at p-value of 0.05 using SPSS version 20.0.
Results. There are total of 96 patients enrolled in the study. The mean age of the entire sample was 71.24 ± 14.89. 32 patients (33%) are classified into shock/septic subgroup, 23 patients (24%) into cardiac/cerebral subgroup, and 41 patients (43%) into other subgroup. The body weight change in the 24-hour period at ICU tends to be positive with the average amount is 35 ± 1427 grams. Otherwise, the input-output fluid balance recorded by nurses demonstrates a consistently negative tendency with average amount is -342 ± 949 mL (mean ± SD). The average difference between the fluid balance measured by two methods is 378 ± 1185 mL (mean ± SD). There are 42 cases (43%) that the difference is larger than 500mL. Within the entire sample, there is no statistically significant difference between the two methods. The Bland-Altman plot above shows that 97% of data points lie within this range, and tend to concentrate around the mean line. The limit of agreement varies from -1945mL to 2702mL. While considering these findings in the clinical setting, the agreement is not good enough to completely eliminate the body weight change out of the clinical practice.
Conclusion. The present study is conducted specifically in Vietnamese patients. There is no statistically significant difference between the body weight change and the input-output fluid balance record. Therefore, it is necessary to maintain both methods in clinical practice.
ABSTRACT 3
ACKNOWLEDGEMENT 5
CONTENT 7
LIST OF TABLES10
LIST OF FIGURES11
CHAPTER 1. INTRODUCTION 12
1.1 Statement of the research12
1.2 Significant of the research 13
1.3 Aim of the research 13
1.4 Chapter summary 14
CHAPTER 2. LITERATURE REVIEW 15
2.1 Introduction15
2.2 Critical care nursing 16
2.3 Fluid balance monitoring in critically ill patients 21
2.4 Methods of fluid balance monitoring 25
2.5 The accurary and reliability of fluid balance monitoring30
2.6 Chapter summary32

CHAPTER 3. RESEARCH METHODOLOGY 34
3.1 Introduction34
3.2 Research setting 35
3.3 Research design 35
3.4 Research framework35
3.5 Sampling issues36
3.6 Data collection 38
3.7 Statistical analysis 42
3.8 Ethic issues43
3.9 Chapter summary 44
CHAPTER 4. RESULTS 45
4.1 Introduction 45
4.2 Sample collection 45
4.3 Demographic characteristics 46
4.4 Admission characteristics 47
4.5 Diagnostic subgroups48
4.6 Patients characteristics according to diagnostic subgroups 50
4.7 Fluid balance parameters according to diagnostic subgroups 51
4.8 Comparison of patient characteristics within the entire sample and among subgroups 53
4.9 Comparison of fluid balance parameters within the entire sample and among subgroups 55
4.10 Agreement between two methods: body weight change and input-output fluid balance 56
CHAPTER 5. DISCUSSION 60
5.1 Introduction 60
5.2 Demographic, admission and diagnostic characteristics 60
5.3 Fluid balance parameters 62
5.4 The agreement between two methods63
5.5 Contribution and implication of the research65
5.6 Limitations of the research 66
5.7 Recommendation for further research 67
CHAPTER 6. CONCLUSION 68
REFERENCES 69
APPENDIXES 75
Appendix I Research approval of Meiho University 75
Appendix II Letter of Approval of University Medical Center 76

LIST OF TABLES
Table 1. Equipment weight at ICU, UMC 41
Table 2. Demographic characteristics46
Table 3. Admission characteristics 48
Table 4. Diagnostic subgroups 49
Table 5. Patient characteristics according to diagnostic subgroups51
Table 6. Fluid balance parameters according to diagnostic subgroups52
Table 7. Comparison of patient characteristics within the entire sample 54
Table 8. Comparison of fluid balance parameters within the entire sample and between each pair of subgroups 56
Table 9. Turkey post-hoc test analysis 57
Table 10. Fluid balance parameters in this study and the study of Perren and colleagues 63
LIST OF FIGURES
Figure 1. Bland-Altman plot and limit of agreement model 32
Figure 2. Research framework35
Figure 3. Sample size calculation by MedCalc software 37
Figure 4. Detecto IBFL Fixed Leg Digital Stretcher Scale at ICU, UMC40
Figure 5. Sample collection 46
Figure 6. Distribution of age by gender47
Figure 7. Distribution of body weight change and input-output fluid balance 58
Figure 8. Bland-Altman plot between the body weight change and input-output fluid balance in all patients 59
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